Screening for c-mpl mutations in patients with congenital amegakaryocytic thrombocytopenia identifies a polymorphism.

a therapeutic approach to children and adolescents with AML that leads to cure half of the time,. .. irrespective of the presence of a. .. family donor. " 1(p61) It is true that the presented event-free survival estimates for both the allogeneic BMT and chemotherapy groups receiving intensively timed induction therapy exceeded 50% (66% and 53%, respectively); this statement is misleading, however, because this analysis includes only children successfully completing induction therapy and in remission (652 of 887). As the authors themselves point out, the overall survival rate from diagnosis for all patients (allogeneic BMT, autologous BMT, and chemotherapy only) receiving intensively timed induction chemotherapy was only 49%. The authors, citing the superior overall survival rate for children receiving matched related allogeneic BMT (allogeneic, 60%; chemotherapy, 53%; autologous BMT, 48%), conclude that " for younger patients, including children and adolescents, allogeneic BMT for AML in first remission is the treatment of choice when a matched related donor is available. " 1(p60-61) The authors imply that, for pediatric patients with a matched related donor, a strategy employing allogeneic transplantation in first remission is more effective than a strategy reserving transplantation for the treatment of relapses. The study's design does not permit such a conclusion to be drawn, since all patients with a matched related donor were assigned to a transplant in first remission. By definition, the only potential allogeneic transplant options available to patients in the other 2 groups in the event of a relapse were alternative donor transplants. A randomized controlled study comparing conventional chemotherapy with allogeneic transplantation involving only subjects with matched related donors would be necessary to definitively answer this question. Understandably, this would be much more difficult to conduct. Reference 1. Woods WG, Neudorf S, Gold S, et al. A comparison of allogeneic bone marrow transplantation, autologous bone marrow transplantation, and aggressive che-motherapy in children with acute myeloid leukemia in remission: a report from the Children's Cancer Group. Treatment of children with acute myeloid leukemia In a recent article, Woods et al report that postremission bone marrow transplantation (BMT) produced better overall survival than chemotherapy in children with acute myeloid leukemia (AML). 1 They also indicate that intensive timing induction improved postremission survival. Their study is impressive in its design, conduct, and magnitude, but their article raises several questions. First, in comparing initial characteristics of patients in the allogeneic BMT (allo-BMT) and chemotherapy groups, no mention is …